Addiction to multiple oncogenes can be exploited to prevent the emergence of therapeutic resistance

Many cancers exhibit sensitivity to the inhibition of a single genetic lesion, a property that has been successfully exploited with oncogene-targeted therapeutics. However, inhibition of single oncogenes often fails to result in sustained tumor regression due to the emergence of therapy-resistant cells. Here, we report that MYC-driven lymphomas frequently acquire activating mutations in β-catenin, including a previously unreported mutation in a splice acceptor site. Tumors with these genetic lesions are highly dependent on β-catenin for their survival and the suppression of β-catenin resulted in marked apoptosis causally related to a decrease in Bcl-xL expression. Using a novel inducible inhibitor of β-catenin, we illustrate that, although MYC withdrawal or β-catenin inhibition alone results in initial tumor regression, most tumors ultimately recurred, mimicking the clinical response to single-agent targeted therapy. Importantly, the simultaneous combined inhibition of both MYC and β-catenin promoted more rapid tumor regression and successfully prevented tumor recurrence. Hence, we demonstrated that MYC-induced tumors are addicted to mutant β-catenin, and the combined inactivation of MYC and β-catenin induces sustained tumor regression. Our results provide a proof of principle that targeting multiple oncogene addicted pathways can prevent therapeutic resistance.Cancer cells are highly sensitive to the targeted inhibition of single driver mutations, eliciting a phenomenon known as “oncogene addiction” (1). The identification of genetic dependencies in multiple tumor types has resulted in the development of several molecularly targeted therapeutics, including the BCR-ABL kinase inhibitor imatinib for the treatment of chronic myelogenous leukemia (CML), the EGFR kinase inhibitor gefitinib for the treatment of non–small cell lung cancer (NSCLC), and the BRAF kinase inhibitor vemurafenib for the treatment of advanced melanoma (2–4). Although these oncogene-targeted agents have provided promising clinical responses, many patients ultimately experience a recurrence of their disease due to the development of drug resistance (4–6). Thus, it has become evident that monotherapy with targeted drugs is insufficient for achieving sustained tumor regression.Resistance to targeted therapy can arise through multiple mechanisms, depending on the tumor type and the targeted oncogenic pathway (7). Cells frequently acquire resistance through mutations in the targeted oncogene itself that disrupt drug binding, as in the case of BCR-ABL and EGFR (8, 5, 6). In addition, resistance to EGFR inhibition in NSCLC and BRAF inhibition in melanoma has been found to occur through a variety of mechanisms that activate downstream signaling proteins or alternative pathways, which can functionally substitute for loss in activity of the targeted oncogene (9–11). Although significant progress has been made in the identification and inhibition of resistance pathways, it may prove challenging to anticipate and suppress all of the potential mechanisms of resistance for each oncogene-addicted cancer and targeted therapeutic agent.Combination therapy has been successfully applied to prevent resistance in the treatment of infectious diseases such as HIV (12, 13) and tuberculosis (14). In the context of oncogene-targeted therapy for cancer, it has been proposed that a similar strategy, using combinations directed against multiple dependencies, is the most likely to prevent resistance (7). Indeed, mathematical modeling indicates that targeting at least two independently required pathways may be sufficient to prevent tumor recurrence (15). However, there exists little experimental evidence directly testing such an approach and it remains unclear which combinations of targets would be most effective at inducing long-term remissions.MYC is one of the most frequently amplified oncogenes in human cancer (16). In the Eμ-tTA/tetO-MYC conditional mouse model, overexpression of MYC results in the development of aggressive T-cell lymphoma, and MYC inactivation in established tumors is sufficient to induce tumor regression through processes such as proliferative arrest, cellular senescence, apoptosis, and the shutdown of angiogenesis (17–19). The extent of regression is dependent on both cell-intrinsic and host-dependent contexts, and in particular, tumors frequently recur following MYC inactivation in the absence of an intact adaptive immune system (20). Recurring tumors restore expression of the MYC transgene or up-regulate expression of endogenous Myc, demonstrating that resistance occurs primarily through reactivation of the MYC pathway (21). Thus, MYC oncogene addiction and tumor recurrence in the Eμ-tTA/tetO-MYC lymphoma model resembles the clinical course of human cancers treated with single agent targeted therapy.Here, we demonstrate that the combined inactivation of two oncogene addiction pathways can result in sustained tumor regression. Moreover, we describe a previously unidentified splice acceptor site mutation in β-catenin that is associated with MYC-induced lymphomagenesis. Tumors with mutations in β-catenin are also highly addicted to this mutant gene product for their survival. We demonstrate that in MYC-induced lymphomas, combined addiction to both MYC and β-catenin can be exploited in a rational manner to prevent the emergence of therapeutic resistance.     

Catalpol protects against 2,3,7,8‐tetrachlorodibenzo‐p‐dioxin‐induced cytotoxicity in osteoblastic MC3T3‐E1 cells

2,3,7,8‐tetrachlorodibenzo‐p‐dioxin (TCDD) is a well‐known environmental contaminant that produces a wide variety of adverse effects in humans. Catalpol, a major bioactive compound enriched in the dried root of Rehmannia glutinosa, is a major iridoid glycoside that alleviates bone loss. However, the detailed mechanisms underlying the effects of catalpol remain unclear. The present study evaluated the effects of catalpol on TCDD‐induced cytotoxicity in osteoblastic MC3T3‐E1 cells. Catalpol inhibited TCDD‐induced reduction in cell viability and increases in apoptosis and autophagic activity in osteoblastic MC3T3‐E1 cells. Additionally, pretreatment with catalpol significantly decreased the nitric oxide and nitrite levels compared with a control in TCDD‐treated cells and significantly inhibited TCDD‐induced increases in the levels of cytochrome P450 1A1 and extracellular signal‐regulated kinase. Pretreatment with catalpol also effectively restored the expression of superoxide dismutase and extracellular signal‐regulated kinase 1 and significantly enhanced the expression of glutathione peroxidase 4 and osteoblast differentiation markers, including alkaline phosphatase and osterix. Taken together, these findings demonstrate that catalpol has preventive effects against TCDD‐induced damage in MC3T3‐E1 osteoblastic cells.     

Higher consumption of sugar-sweetened soft drinks increases the risk of hyperuricemia in Korean population: The Korean Multi-Rural Communities Cohort Study

Objective

The clinical implication of sugar-sweetened soft drinks on the risk of hyperuricemia has increased, especially in Western population studies. The aim of this study is to clarify the association between sugar-sweetened soft drinks and fruit drinks made from oranges and apples and the risk of hyperuricemia in the Korean Multi-Rural Communities Cohort.

Methods

A total of 9400 subjects were enrolled in the Korean Multi-Rural Communities Cohort Study, and a cross-sectional analysis was performed. Five quintiles (Q1–Q5) according to consumption of soft drinks and other fruit/fruit juices were classified and then categorized into three groups (Q1–Q3, Q4, and Q5) to assess the risk of hyperuricemia. Information on dietary intake was collected by well-trained interviewers using validated food frequency questionnaires.

Results

Higher consumption of sugar-sweetened soft drinks (Q5) increased the risk of hyperuricemia in males (adjusted OR = 1.35, 95% CI: 1.07–1.71) with a linear trend (p for trend = 0.01) and in females (adjusted OR = 1.40, 95% CI: 1.03–1.90) with no linear trend (p for trend = 0.09), compared to lower consumption (Q1–Q3). However, there were no significant differences of serum uric acid level according to the three categories of soft drink consumption, Q1–Q3, Q3, and Q5, in males (p = 0.21) or in females (p = 0.16), whereas all subjects showed statistical significance of serum uric acid level within the categories (p < 0.001). Estimated amount of soft drink intake was associated with serum uric acid level in males (β = 0.001; p = 0.01) but not in females (β = 0.0005; p = 0.10).

Conclusion

Higher consumption of sugar-sweetened soft drinks increased the risk of hyperuricemia in the Korean population, showing a differential linear trend for hyperuricemia according to gender.     

Sleep duration and health-related quality of life in Korean adults: 2007-2015 Korea National Health and Nutrition Examination Survey

Sleep and Breathing - To evaluate the association of sleep duration with health-related quality of life (HRQOL) and examine the influence of age, sex, and common comorbidities on this association....     

New-onset insomnia among cancer patients undergoing chemotherapy: prevalence,risk factors,and its correlation with other symptoms

Sleep and Breathing - Although insomnia is common among cancer patients, its prevalence remains variable, and its risk factors and correlation with other cancer-related symptoms are not fully...     

Prognostic factors for outcomes of allogeneic stem cell transplantation in chronic phase chronic myeloid leukemia in the era of tyrosine kinase inhibitors

The aim of this study was to estimate the prognostic factors for the outcomes of chronic myeloid leukemia (CML) patients receiving allogeneic stem cell transplantation (SCT) in chronic phase (CP) in the era of tyrosine kinase inhibitors (TKIs). Ninety-seven patients who underwent allogeneic SCT in CP were analyzed. Forty-seven were TKI-naïve at the time of transplant, and 50 received TKI(s) treatment before transplantation. After a median follow-up of 115.8 months, the 4-year overall survival and event-free survival were 80.4 and 58.8%, respectively. Multivariate analysis showed that there were no differences in survival outcomes based on prior TKI therapy. Older age was a prognostic factor for higher treatment-related mortality (TRM), and the type of graft source and younger age were associated with relapse, but prior TKI therapy and disease status at the time of transplant were not associated with either TRM or relapse. Additionally, a major molecular response at 1 month and an MR^4.5 at 3 months were important predictors of favorable long-term outcomes. This study demonstrates the prognostic factors for the outcomes of allogeneic SCT in CP CML and shows that survival outcomes were not affected by the administration of long-term multi-TKI treatment prior to transplantation.